Skip directly to search Skip directly to A to Z list Skip directly to page options Skip directly to site content
Scientific Data Documentation
Epidemiologic Followup Study, 1986 Health Care Facility Stay
DSN:  CC37.HANES1FU.FCLTY86

                        NHANES EPIDEMIOLOGIC FOLLOWUP STUDY
                         HEALTH CARE FACILITY STAY  1986


Acknowledgments

 The  NHANES  I  Epidemiologic  Followup  Study  (NHEFS),  1986 Health Care
 Facility Stay Public Use tape was prepared by Virginia M. Freid  under the
 direction of Jennifer H. Madans.  Assistance was provided by other members
 of  the NHEFS data management team: Joel C. Kleinman, Fanchon F. Finucane,
 Christine  S. Cox, Sandra T. Rothwell, Brian A. Kissel, Cynthia A. Reuben,
 Michael E. Mussolino,  Helen  E.  Barbano,  Madelyn  A. Lane, and Jacob J.
 Feldman.  Virginia M. Freid, Sandra T. Rothwell, and Dawn M. Scott were in
 charge of data set management.  La-Tonya D. Curl, Patricia  B.  Salins and
 Carole  J. Hunt were in charge of manuscript preparation.  Special  thanks
 are extended  to  Joan  Cornoni-Huntley of the National Institute on Aging
 (NIA) who played an important  role in the development and continuation of
 the NHEFS.  The contribution of  Westat,  the contractor who collected the
 data for this longitudinal study, is also gratefully acknowledged.

 The NHEFS originated as a joint project between  the  National  Center for
 Health  Statistics  (NCHS) and NIA.  It has been funded primarily by  NIA,
 with additional financial  support  from  the  following components of the
 National  Institutes  of  Health  (NIH)  and other Public  Health  Service
 agencies: the National Cancer Institute; the  National  Institute of Child
 Health  and  Human  Development;  the  National  Heart,  Lung,  and  Blood
 Institute;  the  National  Institute on Alcohol Abuse and Alcoholism;  the
 National Institute of Mental  Health;  the  National Institute of Diabetes
 and Digestive and Kidney Diseases; the National Institute of Arthritis and
 Musculoskeletal and Skin Diseases; the National  Institute  of Allergy and
 Infectious  Diseases;  and,  the  National  Institute of Neurological  and
 Communicative Disorders and Stroke.


Use of NHEFS Data

 With  the  goal  of  mutual  benefit,  NCHS requests  the  cooperation  of
 recipients of data tapes in certain actions related to their use:

 A.   Any published material derived from  the  data should acknowledge the
      National Center for Health Statistics (NCHS)  as the original source.
      It  should  also  include  a disclaimer which credits  any  analyses,
      interpretations, or conclusions  reached  to the author (recipient of
      thetape) and not to NCHS, which is responsible  only for the initial
      data.

 B.   Consumers  who wish to publish a technical description  of  the  data
      will make a  reasonable  effort to insure that the description is not
      inconsistent  with that published  by  NCHS.   This  does  not  mean,
      however, that NCHS will review such descriptions.

 C.   Authors should  provide  NCHS  with  a  reprint of published articles
      which utilize the 1986 NHEFS data.  Please send reprints to:
        NHEFS Data Management Staff
        Division of Analysis
        National Center for Health Statistics
        Presidential Building, Room 1080
        6525 Belcrest Road
        Hyattsville, MD 20782

   Note:  New address effective May 1990.


Errors in the Data Tapes and Survey Differences

 The NHEFS Public Use data tapes have been subjected  to  a  great  deal of
 careful  editing.  However, due to the large volume of data in the series,
 it is likely  that  a  small  number  of  errors  or  discrepancies remain
 undetected.

 In  general, the NHEFS data management team has not attempted  to  resolve
 substantive  data  discrepancies  that  may exist 1) within the 1986 NHEFS
 data tapes, or 2) between the 1986 NHEFS  data tapes and the data tapes of
 the original National Health and Nutrition  Examination  Survey (NHANES I)
 and other NHEFS followup waves.


Background 1986

 The NHANES I Epidemiologic Followup Study (NHEFS) is a longitudinal  study
 which  uses  as  its  baseline those adult persons ages 25 to 74 years who
 were examined in the first  National  Health  and Nutrition Survey (NHANES
 I).   The  NHEFS is comprised of a series of followup  surveys,  three  of
 which have been conducted to date.  The first wave of data collection, the
 1982-84 NHEFS,  was  conducted  from 1982 to 1984 and included all persons
 who were between 25 and 74 years at their NHANES I examination (n=14,407).
 This series of tape documentation  describes  data collected in the second
 wave, the 1986 NHEFS.  The 1986 NHEFS was conducted  for  members  of  the
 NHEFS  cohort  who  were 55-74 years at their baseline examination and not
 known to be deceased  at  the  1982-84 NHEFS (n=3,980).  The third wave of
 data collection took place in 1987.  An attempt was made to re-contact the
 entire non-deceased NHEFS cohort  (n=11,750)  at  that  time.   A  plan to
 re-contact the entire non-deceased NHEFS cohort in 1991 is currently under
 review.


Methods 

 NHANES  I  collected data from a national probability sample of the United
 States civilian non-institutionalized population between the ages of 1 and
 74 years.  The  survey,  which included a standardized medical examination
 and questionnaires that covered  various health-related topics, took place
 from 1971 through 1974 and was augmented  by an additional national sample
 in 1974-75.  The NHANES I sample included 20,729 persons 25 to 74 years of
 age,  of whom 14,407 (70 percent) completed  a  medical  examination.  The
 design,  content  and  operation  of NHANES I has been described elsewhere
 (Vital and Health Statistics, Series 1, Nos. 10a, 10b, and 14).

 Although NHANES I provided a wealth  of  information  on the prevalence of
 health  conditions  and risk factors, the cross-sectional  nature  of  the
 original  survey  limits  its  usefulness  for  studying  the  effects  of
 clinical, environmental, and behavioral factors and in tracing the natural
 history of disease.   Therefore, the NHEFS was designed to investigate the
 association between factors  measured  at  baseline and the development of
 specific health conditions.  It has been jointly sponsored by the National
 Center for Health Statistics (NCHS), the National  Institute on Aging, and
 other components of the National Institutes of Health  and  Public  Health
 Service.  The 14,407 participants who were 25 to 74 years of age when they
 were  examined  in  NHANES  I (1971-75) are included in the followup study
 population.

 In the first wave, the 1982-84  NHEFS,  data  were collected on all 14,407
 subjects (i.e., individuals examined at NHANES  I) in the cohort.  Tracing
 of subjects began in 1981 and data collection was  conducted  from 1982 to
 1984.   Approximately 93 percent (n=13,383) of the cohort was successfully
 traced by  the  end  of  the  survey  period.  Detailed information on the
 design, content, and operation of the 1982-84  NHEFS  may  be found in the
 Plan  and Operation of the NHANES I Epidemiologic Followup Study  1982-84,
 Vital and  Health  Statistics,  Series 1, No. 22.  The basic design of the
 1982-84 NHEFS consisted of the following components:

          tracing subjects or their proxies to a current address;

          acquiring death certificates for deceased subjects;

          performing in-depth interviews  with  the subjects or with their
          proxies including, for surviving subjects,  taking  pulse, blood
          pressure, and weight measurements of subjects; and,

          obtaining hospital and nursing home records, including pathology
          reports and electrocardiograms.


 The  1986  NHEFS,  the second wave of the NHEFS, collected information  on
 changes in the health  and  functional  status since the last contact with
 the  older  members  of  the NHEFS cohort.  It  was  restricted  to  those
 subjects who were at least  55  years  old  at  their NHANES I examination
 (n=5,677), which is almost 40 percent of the entire  NHEFS  cohort.   This
 group includes 1,697 subjects who were deceased at the time of the 1982-84
 NHEFS and 3,980 subjects who were not known to be deceased at the time  of
 the  1982-84  NHEFS.   The  1982-84  NHEFS  decedents  were  excluded from
 additional data collection in the 1986 NHEFS.  Tracing and data collection
 were  undertaken  for the 3,980 subjects not known to be deceased  in  the
 1982-84 NHEFS, regardless  of  their  tracing  or interview status in that
 survey.  The design and data collection procedures  adopted  in  the  1986
 NHEFS  were  very  similar  to  the  ones developed in the 1982-84 Survey:
 subjects (or their proxies) were traced; subject and proxy interviews were
 conducted; and, health care facility abstracts and death certificates were
 collected.  For more information on the  1986  NHEFS,  see  the  Plan  and
 Operation: NHANES I Epidemiologic Followup Study, 1986 (a Vital and Health
 Statistics, Series 1, No. 25).

 Tracing  began  in  November  1984 for the 1986 NHEFS.  A large variety of
 tracing sources were used in order  to  locate subjects.  For example, all
 subjects were matched against information  from  the  National Death Index
 (NDI) and the enrollee files of the Health Care Financing  Administration.
 The additional tracing sources used in the 1986 wave, though,  depended on
 the  subject's  vital status in the 1982-84 NHEFS.  Subjects who had  been
 successfully traced  alive  in  the  1982-84  NHEFS  underwent  one set of
 tracing procedures while those who had not been successfully traced in the
 1982-84 NHEFS underwent another.

 Date  and place of death were obtained for all subjects identified  during
 tracing  as  deceased.   These  data  were  used  to  obtain a copy of the
 subject's  death certificate from the appropriate State  Vital  Statistics
 office.  A death identified by the NDI or by the other tracing methods was
 also verified  by obtaining the death certificate from the State of death.
 All  death  certificates  were  coded  by  NCHS  using  the  International
 Classification  of  Diseases,  Ninth  Revision and multiple cause-of-death
 codes.

 All subjects who could not be located through  the tracing procedures were
 considered lost-to-followup in the 1986 NHEFS.  In some cases, information
 about  the  death  of  a subject was obtained from a  former  neighbor,  a
 relative or another tracing  source.   Although this information was noted
 in the subject's tracing record, he or she was considered lost-to-followup
 unless the information was verified by means  of  a  death  certificate or
 proxy interview.  A subject's death had to be confirmed by either  a death
 certificate or proxy interview.

 In  addition  to verifying the subject's vital status, the tracing process
 also was used to obtain the current address of a surviving subject as well
 as to identify  a knowledgeable proxy respondent for a deceased subject or
 a surviving but incapacitated  subject.   Respondents  (i.e.,  subjects or
 their  proxies)  who  were  identified  and  located  through  the tracing
 procedure  were  then  contacted  and  asked to participate in a telephone
 interview.   In a few cases, subjects who  had  been  traced  successfully
 could not be relocated for the interview.  Only their vital status and the
 date when they were last traced in the 1986 Survey are available.

 A major difference between the 1982-84 and 1986 NHEFS waves was the manner
 in  which the interviews  were  conducted.   In  the  1982-84  NHEFS,  the
 two-hour  subject  interview usually was conducted in-person while, in the
 1986 NHEFS, the interview  was  shortened  to 30 minutes in length and was
 conducted primarily by telephone.  In addition,  since  the  questionnaire
 was not administered in-person, no physical measurements were  made in the
 1986 NHEFS.

 The  1986  NHEFS  interviews  were  conducted  over the telephone using  a
 Computer  Assisted  Telephone  Interviewing  (CATI)  system.   CATI  is  a
 telephone interviewing technique that allows the  interviewer to enter the
 answers  supplied  by  the respondent directly into the  computer.   Thus,
 editing and coding time  is  reduced  and  keypunching  from  a  hard copy
 questionnaire  is eliminated.  A computer program drives the questionnaire
 so  that the correct  skip  patterns  are  followed  and  the  appropriate
 questions  are  displayed  on the computer monitor.  The skip patterns are
 based on information gathered  from  previous  data collection waves or on
 responses provided during the interview.  For example,  the  questions  on
 pregnancy   and  menstrual  history  in  the  1986  NHEFS  interview  were
 programmed to  be  skipped automatically if the subject was male or if the
 female subject had had an interview in 1982-84.  Edit and logic checks are
 incorporated into the  data  collection  system itself, thus improving the
 quality of the data.

 The 1986 NHEFS included a health care facility record collection component
 designed to provide information on all overnight  stays for subjects since
 their last interview.  Subjects were eligible for this component if either
 an interview or a death certificate had been collected  for  them  in  the
 1986 Survey.

 As  of  July  28,  1986,  the  end  of  the 1986 NHEFS survey, 3,767 (94.6
 percent)  of  the  3,980  members  of  the  1986  NHEFS  cohort  had  been
 successfully traced.  Interviews were conducted  for  3,608 subjects (95.8
 percent of those successfully traced), 167 of which were  conducted during
 three  pretest  periods in 1985 and 3,441 during a main survey  period  in
 1986.  In addition,  5,405  facility stay records were collected for 2,021
 subjects.  Death certificates  were obtained for 616 (97.0 percent) of the
 635 subjects who were known to have died since last contact.

 The data collected from the 1986 NHEFS are stored on four separate tapes:

      1)   Vital and Tracing Status tape -- contains vital status, tracing,
           and demographic information on all subjects 55 years or older at
           NHANES I,

      2)   Interview tape -- contains  the  data  collected  from  the 1986
           NHEFS subject and proxy interviews,

      3)    Mortality Data tape -- contains data abstracted from the  death
            certificate  for  all  known  decedents  aged  55  years  or
            older at NHANES I for whom a death certficate was obtained,

      4)   Health Care Facility Stay tape -- contains information collected
           during  the  1986  NHEFS  on  reports of stays in hospitals  and
           nursing homes, as well as information  abstracted  from facility
           medical records.  This tape is discussed below in the  following
           pages.


Stay Reports


 The 1986 NHEFS Health Care Facility Stay file contains information  on all
 overnight  health  care  facility  stays  for members of the 1986 Followup
 cohort.  The 1986 Followup cohort consisted of the 3,980 subjects who were
 at least 55 years old at their NHANES I examination  and were not known to
 be deceased at the time of the 1982-84 NHEFS.  Followup cohort members who
 have  either an interview or a death certificate on the  1986  NHEFS  data
 files were  eligible  for the health care facility records component.  The
 aim of this component was  to  develop  a  complete  set  of  health  care
 facility (i.e., hospital and nursing home)  records for each 1986 Followup
 cohort  member.   This  was accomplished by identifying all facility stays
 through a series of reporting  mechanisms.   Facilities  were contacted to
 obtain copies of medical records.  Reports and medical records  were  then
 linked  and the 1986 NHEFS Health Care Facility Stay file was constructed.
 The  procedures   for  obtaining  reports  and  collecting  abstracts  are
 described in detail  in  the  Plan  and Operation:  NHANES I Epidemiologic
 Followup Study, 1986 (Vital and Health  Statistics,  Series  1,  No.  25).
 They are outlined briefly, below.

 The 1986 NHEFS Health Care Facility Stay file contains all information  on
 overnight stays that are in-scope for the 1986 NHEFS period.  For subjects
 interviewed  during  the 1982-84 NHEFS, the 1986 in-scope survey period is
 from the date of the 1982-84  interview  to the date of the 1986 interview
 for surviving subjects and from the date of  the  1982-84 interview to the
 date of death for deceased subjects.  The 1986 in-scope  survey period for
 subjects who were not interviewed in the 1982-84 NHEFS is from the date of
 NHANES  I  examination  to  the  date of the 1986 interview for  surviving
 subjects and from the date of NHANES  I  examination  to the date of death
 for  deceased subjects.  Stays that were reported prior  to  the  in-scope
 period were defined as out-of-scope for the 1986 survey.


Identification of Stay Reports

 Reports  of  overnight  hospital or nursing home facility stays were obtained
 from  various sources.  Most  reports  were  elicited  through  a  series  of
 detailed  questions  in  sections  B  and  F  of  the  interview.  Generally,
 respondents were asked to report all overnight facility  stays  since 1980 if
 the  subject was last interviewed in the 1982-84 NHEFS or since 1970  if  the
 subject  was  last  interviewed  at  NHANES  I  examination.   In addition to
 interview  information,  data  on  facility  stays  were gathered from  other
 reporting sources:  from the death certificate, tracing  sources,  and  other
 hospital  abstracts.   At  the conclusion of the interview, authorization was
 obtained for permission to contact facilities.


Facility Data Collection

 For each stay reported during  the  interview,  the  name  and address of the
 facility, the reported dates of the stay, and the reason for  the  stay  were
 recorded  on the hospital and health care facility chart (HHCF).   A separate
 log book was kept containing similar data for reports gathered from the death
 certificates,  tracing sources, and other hospital abstracts.  All reports of
 facility stays were compiled and entered into a computerized tracking system.
 All reported facilities  were  contacted  by  mail  and  asked  to review the
 subject's  medical  records  and  to  abstract information on exact dates  of
 admission, discharge and diagnoses onto standard abstract forms.  In addition
 to completing abstract forms, facilities were requested to submit photocopies
 of selected sections of the subject's inpatient record i.e., the "facesheet",
 the  discharge  summary,  the  third  day  EKG   (for  myocardial  infarction
 diagnoses, 410 in the International Classification of Diseases, 9th Revision,
 Clinical Modification (ICD-9-CM)) and of pathology reports (for any admission
 where a new malignancy was diagnosed).


Matching Records

 As  the  abstracts  were  received,  they  were  checked   against  report
 information in the tracking system to determine if the abstract  "matched"
 any  of the reported stays.  Date of admission and diagnosis were used  as
 matching criteria but exact matches on date or diagnosis were not required
 for a stay to be considered matched.  Abstracts were matched to reports if
 the reported  date  of  admission  was within a year of the actual date of
 admission and if the reported reason  for admission involved the same body
 system as at least one of the diagnoses  present  on  the abstract.  Cases
 that did not meet these specific criteria were reviewed  by NCHS staff and
 matched  when  appropriate.   Since  the  matching  rules allowed  for  an
 admission  date  of up to one year before or after the  reported  date  of
 admission, some stay  records  are present on the file with a match record
 status, an out-of-scope report date, but an in-scope date on the abstract.
 These records are identified by a Type C flag in position 199 of the file.

 Each record on the file represents an overnight facility stay.  Therefore,
 one or more records will exist for  some  1986  Followup  cohort subjects,
 while other subjects will have no records on the file.  The  structure  of
 the  data  file  reflects  the  system  used  to  obtain  and process stay
 information.   The  record  is divided into four major sections:   1)  the
 report section,  2) the record  status  section,  3)  the abstract section
 and,  4)  the  related stay section.  An example of the record  layout  is
 provided in figure 1.

 The subject identification  number (i.e. the sample sequence number) is in
 positions 1-5 on each record.   This number is unique for each subject and
 is used when linking the Health Care Facility Stay tape to all other NHEFS
 and NHANES I Public Use Data Tapes.   The  total  number  of  records  per
 subject  is  found in positions 6-7 on the file.  The first section of the
 record is the  report  section (positions 29-59 and 63-204) which contains
 information from the reporting  source  as  well  as  stay  identification
 numbers  assigned by NCHS.  Each stay entered into the report  section  is
 assigned a  health  care  facility stay id number (positions 29-33).  When
 used in conjunction with the  sample sequence number, this number uniquely
 identifies each record on the file.   The  reported  date  of admission is
 found in positions 47-54.  This date is used in conjunction  with the last
 interview date to determine whether reported stays were in-scope  for  the
 NHEFS 1986 survey (position 199).

 The record status section (positions 60-62) contains a code for the result
 of  the  abstract  request, i.e. match or non-match status.  If a facility
 returned an abstract  that  matched  a report then a record status code of
 MAT (match) was applied.  A returned abstract  that did not match a report
 but was in-scope for the 1986 survey period was assigned the record status
 code  of  ASF  (additional  stay  found).   A record status  code  of  CRM
 (cross-referenced match) was applied to a stay  that  was the continuation
 of a stay begun prior to the 1986 NHEFS survey period.  If an abstract was
 not returned, the appropriate non-match code was assigned.

 The abstract section (positions 205-379) contains the information obtained
 from  the facility records including actual dates of admission,  discharge
 and diagnoses.   The  diagnoses  on  the  abstracts  were  coded using the
 ICD-9-CM  according to the medical coding specifications detailed  in  the
 following section  of  this  codebook.  The abstract section is similar to
 the original 1982-84 NHEFS Health  Care  Facility  record file released in
 August, 1987 while the other three sections are new additions to the NHEFS
 1986 facilty tape format.  (A revised file which restructures  the 1982-84
 Health Care Facility data into the current format has also been released.)

 Information  will  be  present  in  one  or  more  sections  of the record
 depending  on  whether a report was obtained, and whether an abstract  was
 received.  The presence  or  absence  of  information  in  the first three
 sections results in three different record profiles.  Figure 2 illustrates
 these three profiles.  The first is the successfully matched  stay record,
 where   an  abstract  was  received  which  matched  a  report.   Abstract
 information  is  added  to the report and the code of MAT was entered into
 the record status section.  Complete information is available in the first
 three sections of the record for these stays.  The second type occurs when
 an abstract was not matched  to  a  report  and,  therefore,  no  data  is
 contained  in  the  abstract  section.  The appropriate non-match code was
 entered in the record status section.   The  third  type  of record is one
 which  was  generated solely by the receipt of a facility abstract.   This
 type of record  resulted  when  the facility returned an in-scope abstract
 that did not match with any report  on  the  tracking  system.   When this
 occurred, the abstract was entered on the file, and stay identifiers  were
 assigned  in  the report section of the record but no other information in
 the report section  is  present.   An ASF (additional stay found) code was
 entered in the record status section.

 Due  to the procedures we instituted  for  maximizing  the  collection  of
 reports  of  hospital or nursing home stays, i.e., deliberately requesting
 out-of-scope report  information,  it  was  necessary  to devise rules for
 removing  the  "correctly  reported" out-of-scope reports from  the  final
 version of the file.  This was only possible after the facilities returned
 abstract information to us.   Reports  of  stays  with  a reported date of
 admission more than one year prior to the last interview  in  health  care
 facilities  which  had  not  been contacted previously were flagged with a
 Type D in position 199.  If an  in-scope  abstract  was  received from the
 facility it was added onto the file with a record status code  of ASF, and
 the Type D report was deleted from the final version of the file.   If the
 facility  responded  to  the  request  for  information  but  no  in-scope
 abstracts  were  received from the facility, the Type D report was deleted
 from the file based  on  the  presumption that the date had been correctly
 reported and the stay was out-of-scope.   In  20 cases, the Type D reports
 remain  on  the  final version of the file.  This  occurred  when  it  was
 impossible to contact  the  facility  or  the  facility did not return any
 information to us.  These records for unconfirmed  reports of out-of-scope
 stays can be eliminated from analyses at the analysts' discretion.  A Type
 C flag was assigned in position 199 when a reported  date of admission was
 within  one year of the previous interview.  If an in-scope  abstract  was
 returned  which matched the Type C report, it was assigned a record status
 code of MAT (n=73).  (The matching rules permitted an admission date of up
 to one year  before  or  after  the  reported  date of admission).  If the
 facility  responded but no in-scope abstracts were  received  the  Type  C
 reports were  removed  from  the  file  again  on  the assumption that the
 correct date had been reported and the stay was truly out-of-scope.  In 10
 cases it was not possible to contact the facility, and  the Type C reports
 remain on the file.  These unconfirmed reports of out-of-scope  stays  are
 identified  by  a non-match status in positions 60-62 and a Type C flag in
 position 199.

 The final section  of  the  record, the related stay codes (positions 380-
 429), are used to identify stays  which  are contained within other stays.
 This occurred most often when nursing home  residents had a brief hospital
 stay but then returned to the nursing home.   A  detailed  example  of the
 related  stay  section  is  presented  below.   In  panel A, a chronologic
 history  of a subject's hospital and nursing home stays  is  presented  in
 order to facilitate  the  discussion  of  the  related  stay  codes.  This
 subject was admitted to the nursing home on March 1, 1985, and  discharged
 to  the  hospital  on  April 1, 1985.  He returned to the original nursing
 home on April 8 and stayed  until April 22 when he required readmission to
 the hospital.  He returned from  the hospital to the nursing home on April
 25, 1985 where he remained until April 30, 1985.

Panel A:  Chronologic profile of hospital and nursing home stays

 Location         Admission      Discharge
 Nursing home     03/01/85       04/01/85
 Hospital         04/01/85       04/08/85
 Nursing home     04/08/85       04/22/85
 Hospital         04/22/85       04/25/85
 Nursing home     04/25/85       04/30/85

Panel B:  Final file layout

 Panel B illustrates how these stays  are  present  in the final file.  The
 three  nursing  home  stays  were collapsed into one long  stay  with  two
 related  hospitalizations.   The   related   stay   codes  were  added  to
 demonstrate the relationship between the hospital and nursin home stays.

 Variable Position:
 29-33   209     210-215    216-221   380-384   385-389

 Variable Name:
 Stay                         Dis-      First     Second
 Number  Type       Admit     charge    Related   Related

 20201   N. Home   03/01/85  04/30/85   20101     20102
 20101   Hosp      04/01/85  04/08/85   20201
 20102   Hosp      04/22/85  04/25/85   20201


Coding Procedures and Guide to Tape Layout

 Medical Coding Specifications

 Medical coding for the NHEFS 1986 data tape was based on the International
 Classification of Diseases-9th Revision-Clinical Modification  (ICD-9-CM).
 The  health  care  facility  was  asked  to  abstract  all  diagnoses  and
 procedures  onto  a  special  form.  In most cases, a copy of the hospital
 discharge summary and/or medical  records  facesheet  was  attached to the
 abstract.  The diagnoses and procedures listed on the discharge summary or
 facesheet  were  then  compared with those provided on the abstract  form.
 In most instances, discrepancies  were resolved by coding the diagnoses or
 procedures as provided on the discharge summary or the facesheet.

 All diagnoses were coded to the highest  level  of  specificity  possible.
 The  fourth-digit  subcategory for diagnosis and procedure codes was  used
 whenever possible.   The  fifth-digit  subclassification  of  disease  for
 diagnosis  codes  was  also used when appropriate.  A three-digit ICD code
 was used only if it could  not be further subdivided.  The following rules
 were used to code diagnoses and procedures.

 Rules Governing Medical Coding of Diagnoses

 All medical diagnoses listed  on the health care facility abstract form or
 the discharge summary are coded  in  the order in which the diagnoses were
 listed.  The principal diagnosis is the  condition established after study
 to be chiefly responsible for occasioning  the admission of the patient to
 the health care facility.  The admitting diagnosis  is  not  used  as  the
 principal  diagnosis  unless the admitting and discharge diagnoses are the
 same.
          Ex:  Patient admitted with a diagnosis of bronchopneumonia. After
          workup and treatment,  x-ray  findings,  etc.,  the  patient  was
          discharged  with  a  final  diagnosis  of  bronchopneumonia.  The
          principal diagnosis is coded 485 for bronchopneumonia.

 Note  that the facility was asked to select the principal diagnosis and no
 review  of  the records was made to determine if the correct diagnosis was
 selected.

 All other diagnoses  or  conditions  existing  at the time of admission or
 that developed subsequently during the stay are coded.
          Ex:   Patient  was  admitted  with  a diagnosis  of  uncontrolled
          diabetes  mellitus,  and  during the course  of  examination  and
          treatment,  phlebitis  was  discovered.   The  diabetes  and  the
          phlebitis are coded.

 Diagnoses  documented  as  probable,  possible,  suspected,  question  of,
 suggestive of, compatible with, or questionable  are  coded  and  prefixed
 with a "P".
          Ex:   If  the diagnosis is stated possible myocardial infarction,
          the diagnosis code is P410.9.

 If a diagnosis is stated as "rule out" or "R/O", the condition is coded as
 if it exists and the  "P" prefix is not used.  If a diagnosis is stated as
 "ruled out", the condition is not coded.
          Ex:  If "R/O M.I." appears on the facesheet, the code is 410.9
               If "M.I. ruled out" appears, the condition is not coded.

 Hospital acquired infections,  such  as a "staph" infection, if documented
 on the facesheet and/or discharge summary are coded.  Documentation may be
 in the form of a note by the infections  committee, stamped notation, or a
 checkmark, depending on the record format.

 Malignant neoplasms are coded according to  ICD-9-CM coding specifications
 which indicate primary site of origin.

 Injuries and poisonings are coded, where applicable, using both the nature
 of the injury and the external cause of injury code (E800-E999).
          Ex:  Patient sustained comminuted fracture  of the femur due to a
          fall down stairs.  Nature of injury code is 821.00  and  external
          cause of injury code is E880.9

 "History of" conditions are not coded with the following exceptions:

          Old myocardial infarction (more than 8 weeks since last occurrence)
          Status post bypass surgery
          Malignant neoplasm (cancer in remission or under treatment)
          Old cerebrovascular accident
          Sterilization
          Normal pregnancy undelivered
          Manipulation of an IUD

 These diagnoses are coded using  "V"  codes  and  were  used  on a limited
 basis.   Recurrent malignancy codes are prefixed with an "R".

 Symptoms  (ICD-9-CM  codes  7800-7999)  were  coded  using  the  following
 guidelines:
     1.   When  the  only diagnosis listed on the abstract form, facesheet,
          and/or discharge summary is a symptom, the symptom is coded.

          Ex:  The only  discharge  diagnosis  listed is "chest pain".  The
          code number 786.50 (chest pain, unspecified) is assigned.

     2.   When  a  symptom  is  listed  that is unrelated  to  any  of  the
          diagnoses listed, the symptom is coded.

          Ex:   The  discharge  diagnoses  listed   are   acute  myocardial
          infarction,    diabetes   mellitus,   and   hepatomegaly.     The
          hepatomegaly is also coded.

     3.   When a symptom is  listed  and  is  related to a listed discharge
          diagnosis the symptom is not coded.

          Ex:  The discharge diagnoses listed are  diabetes mellitus, acute
          appendicitis, severe abdominal pain.  Only  the  diabetes and the
          appendicitis are coded.  The abdominal pain is not coded.


 Rules Governing Medical Codes for Procedures

 The same general rules apply to coding procedures as to coding  diagnoses.
 Medical  procedures  are  coded  and  sequenced  in  accordance  with  the
 principal  and  secondary procedures described on the health care facility
 abstract form or the discharge summary/facesheet.

 The principal procedure  is  the  primary  procedure  most  related to the
 principal diagnosis and is performed for definitive treatment  as  opposed
 to diagnostic and/or exploratory purposes.
          Ex:  Diagnosis  = uterine fibroids.
               Procedures = biopsy of uterus, total abdominal
                          hysterectomy, incidenta appendectomy.

               The hysterectomy is coded as the principal procedure and the
               appendectomy   and   the   biopsy  are  coded  as  secondary
               procedures.

 All procedures documented on the discharge  summary  and/or  facesheet are
 coded if they fall into the following categories:
          Biopsies (if related to the principal diagnosis and procedure  or
          if related to other listed diagnoses)

          Surgical procedures

          Cardiac catheterizations

          D and C (following delivery or abortion only)

 The following procedures are not coded:

          Surgical approach

          Operative cholangiogram

          Lumbar puncture

          CT scan

          Endoscopy

          Diagnostic D and C

          Diagnostic radiology

          Examination (under anesthesia, physical exam, etc.)

          Manipulations

          Physical therapy

          Application or removal of casts, splints, etc.


Medical Coding Conventions

 Diagnostic  codes--Up  to  ten  diagnoses  are coded for each hospital and
 nursing home stay.  The format for each diagnosis  code  is six positions.
 The following conventions were used when entering diagnostic  codes on the
 data tape:

     1.   ICD-9-CM  diagnostic  codes  (including  "V"  codes) were entered
          beginning  with  the  second  position  of  the  variable   field
          continuing  through  the  sixth  position.   There  is an implied
          decimal  point  between  the  fourth and fifth positions  of  the
          variable field.

     2.   If  the  diagnoses  code  required  less  than  five  digits  the
          remaining tape positions are blank.

     3.   Prefix codes "P" and "R" are coded in the first tape position. If
          the diagnosis code has no prefix the first position is blank.
             Ex. 1:  _ 4 2 2 9 0    Code is 422.90
             Ex. 2:  _ V 7 1 1 _    Code is V71.1
             Ex. 3:  _ 4 3 6 _ _    Code is 436
             Ex. 4:  P 1 8 0 0 _    Code is P180.0
             Ex. 5:  R 1 7 4 9 _    Code is R174.9

     4.   E codes - External cause of injury codes
          An external cause of injury code is  provided,  when  applicable,
          immediately  after the medical diagnosis code which describes the
          nature of the  injury.   E  codes  were  entered on the data tape
          beginning  in  the  first  position  of  the variable  field  and
          continuing  through  the  fifth position.  There  is  an  implied
          decimal  point between the fourth  and  fifth  positions  of  the
          variable field.   If  an E code required less than five positions
          the  remaining  positions  are  blank.   If  an  E  code  is  not
          applicable (i.e.   the  medical diagnosis code is not a nature of
          injury code)  or could not be coded, the variable field is blank.
               Ex. 1:  E 9 0 6 1      Code is E906.1
               Ex. 2:  E 8 5 1 _      Code is E851

 Procedure codes--Up to five procedures  are  coded  for  each  health care
 facility  record.   Each procedure code is formatted in a field containing
 four positions. Procedure  codes  were  entered  beginning  with the first
 position  of  the  variable field continuing through the fourth  position.
 There is an implied  decimal  point between the second and third positions
 of  the  variable field.  If a procedure  code  required  less  than  four
 positions the remaining positions are blank.
               Ex. 1:  4 2 9 2      Code is 42.92
               Ex. 2:  0 3 1 _      Code is 03.1



Record Layout 

 Tape
 Position   Frequencies   Variable Description and Codes

                          SUBJECT INFORMATION

 1-5        5405          NHANES I Sample Sequence Number

 6-7                      Record Count

            5405          01-29 = Total number of records

                          Note:   Each  record  on  the  file  represents an
                          overnight stay in a health care facility (hospital
                          or  nursing  home).  This variable identifies  for
                          each subject the  total  number  of records on the
                          file.   It  will be the same for each  record  the
                          subject has on the file.

 8-28       5405          Blank

 Tape
 Position   Frequencies   Variable Description and Codes

                          STAY  IDENTIFIERS   AND  REPORTED  INFORMATION  ON
                          FACILITY STAYS

                          Note:  The report section of the record (positions
                          29-59  and  63-204) contains  the  information  on
                          health care facility  stays  that  was reported on
                          the  questionnaire,  on  a  death certificate,  on
                          another hospital/nursing home  abstract  form,  or
                          obtained from other sources.

 (29-33)                  Health Care Facility Stay ID Number

                          Note:   When  used  in conjunction with the sample
                          sequence number this  number  uniquely  identifies
                          each record on the tape.  It is composed  of three
                          variables:   Survey  Period  Identifier,  Facility
                          Number  and  Stay  Number  Within  Facility.   For
                          example:  a  Stay  Number  of  20102  refers  to a
                          facility  stay reported during the NHEFS 1986 wave
                          (2)  in  the  first  facility  reported  for  that
                          subject (01)  but  the  second  admission  to that
                          facility (02).

 29                       Survey Period Identifier

            5405          2 = NHEFS 1986

                          Note:   This variable identifies the survey period
                          in which the stay data were collected.  A facility
                          stay reported  during  the NHEFS 1986 wave will be
                          identified with a code number "2".  All records on
                          this file are coded "2" in this field.

 30-31                    Facility Number

            5405          01-08 = Hospital/nursing home number

                          Note:  For each NHEFS subject,  a two digit number
                          was  assigned  to each facility in  which  a  stay
                          occurred.  Thus,  if  a subject had multiple stays
                          at the same facility, all stays will have the same
                          facility number.

                          Facility  numbers  were  assigned   consecutively.
                          However,  due  to tape editing, there are  missing
                          numbers in the sequence of facility numbers.

 32-33                    Stay Number Within Facility

            5385          01-30 =   Stay number
            20            00 = D stay record

                          Note:  The two digit stay numbers were assigned to
                          identify different  stays  in  the  same facility.
                          Type D stay records were assigned a stay number of
                          "00".  A type D stay record is defined  as  a stay
                          with a reported admission date more than one  year
                          prior  to the date of last interview (see position
                          199).

                          Stay  numbers   within  facilities  were  assigned
                          consecutively.   However,  due  to  tape  editing,
                          there are missing  numbers in the sequence of stay
                          numbers within facilities.

 34-35                    Facility ID Prefix

            4784          01 = Hospital
             528          02 = Nursing home
              93          03 = Out of country,  don't  know, not ascertained

                          Note: This variable identifies the type of facility
                          to which the request for a stay record was mailed.

 36-46      5405          Blank

 Tape
 Position   Frequencies   Variable Description and Codes

 (47-54)                  Reported Admission Date/Range

                          The date of admission to a facility is reported by
                          month, day and year.  A range of years  was  coded
                          when the respondent was unable to recall the exact
                          year of admission.  When the year of admission was
                          reported  as  a  range,  the beginning year of the
                          range is found in positions  51-52  and the ending
                          year  of  the  range is found in positions  53-54.
                          Except  for type  D  (position  199)  records  the
                          reported  date  of  admission  is  present for all
                          source  code  2 and 4 records (see position  200),
                          and CRM and CRX records (positions 60-62).

 47-48                    Reported Month of Admission

            2674          01-12 = Month of admission
            1592             98 = Don't know
              20             99 = Not ascertained
            1119          Blank = Type D  (position 199), record status code
                          ASF (positions  60-62), source code 1 or 3
                          (position  200)  and  record  status  code
                          (positions 60-62)  not  a cross-referenced
                          stay (CRM, CRX)

 49-50                    Reported Day of Admission

            1175          01-31 = Day of admission
            3091             98 = Don't know
              20             99 = Not ascertained
            1119          Blank =  Type D (position 199), record  status code
                          ASF (positions 60-62), source code  1 or 3
                          (position  200)  and  record  status  code
                          (positions  60-62)  not a cross-referenced
                          stay (CRM, CRX)

 51-52                    Reported Year of Admission or Beginning Year of Range

            4030          70-86 = Year  of  admission  or  beginning year of
                                  range (1970-1986)
             239             98 = Don't know
              17             99 = Not ascertained
            1119          Blank =Type  D (position 199), or  record  status
                                 code ASF (positions 60-62), or source code
                                 (position  200)  1  or 3 and record status
                                 code    (positions    60-62)     not     a
                                 cross-referenced stay (CRM, CRX)

 53-54                    Reported Year of Admission - Ending Year of Range

            322           73-86 = Ending year of range (1973-1986)
           5083           Blank = No  range  given  for  reported   year  of
                                 admission,   type  D  (position  199),  or
                                 record status  code ASF (positions 60-62),
                                 or source code (position  200)  1 or 3 and
                                 record status code (positions 60-62) not a
                                 cross-referenced stay (CRM, CRX)


 Tape
 Position   Frequencies   Variable Description and Codes

 (55-59)                  ID Number of Cross Referenced Facility Status Stay

                          Note:  The ID number on the 1982-84 NHEFS Facility
                          Tape (positions 29-33) is used to  reference stays
                          in  a  hospital or nursing home that began  during
                          the 1982-84  NHEFS  period and which continue into
                          the 1986 survey period.   This  variable  is coded
                          only  for  records  with a CRM or CRX in positions
                          60-62 on the 1986 file.

 55                       Survey  Period  Identifier   of   Cross-referenced
                          Facility Stay

             132              1 = NHEFS 1982-84
            5273          Blank = Stay not cross-referenced

 56-57                    Facility Number of Cross-referenced Stay

             132          01-06 = Stay number
            5273          Blank = Stay not cross-referenced

 58-59                    Stay Number Within Facility of Cross-reference Stay

             132          01-03 = Stay number
            5273          Blank = Stay not cross-referenced

                          RECORD STATUS

                          Note:   The  record  status  section of the record
                          (positions  60-62)  contains  information  on  the
                          outcome of the request for a health  care facility
                          stay.

 60-62                    Record Status Code

                          Note:  See Appendix A  for an explanation  of  the
                          record status codes.

            5405          ANO - XRD = Record status code

 Tape
 Position   Frequencies   Variable Description and Codes

 (63-198)                 Reported Conditions and Codes

                          During  the process of completing the Hospital and
                          Health  Care  Facility  Chart  (HHCF)  respondents
                          described   the   conditions  that  led  to  their
                          overnight facility  stays.   This  information  is
                          included  as  a  text  field  on  the stay record.
                          Space is allotted for the recording  of up to four
                          reasons for the hospital or nursing home stay (see
                          positions 67-96, 101-130, 135-164 and 169-198).

                          A   numeric   code   was  assigned  to  each  text
                          description to aid the  researcher  in  the use of
                          this  information  (see  positions  63-64,  97-98,
                          131-132, 165-166).  These variables should be used
                          in  conjunction  with  information in the abstract
                          section, i.e, ICD-9-CM diagnosis codes, present on
                          records with a record status  code  of MAT, ASF or
                          CRM.   Appendix B contains a complete  description
                          of these  fields  along  with guidelines for their
                          use.

 (63-96)                  First Reported Condition

 63-64                    Condition Code

            4174          01-37 = Condition code (See Appendix B)
            1231          Blank = Source Code equal  to  2  or  3  or D stay
                                 record or Record Status Code ASF or source
                                 code equal to 1 and record status code not
                                 CRM.

 65-66      5405          Blank

 67-96                    Condition Text

            4174          Description of reason for facility stay
            1231          Blank = Source  Code  equal  to  2  or 3 or D stay
                              record or Record Status Code ASF or source
                              code equal to 1 and record status code not CRM.

 Tape
 Position   Frequencies   Variable Description and Codes

 (97-130)                 Second Reported Condition

 97-98                    Condition Code

            1481          01-36 = Condition code (See Appendix B)
            3924          Blank = Source Code equal to 2 or 3 or D stay
                                 record or Record Status Code ASF or source
                                 code equal to 1 and record status code not
                                 CRM or only one condition reported

 99-100     5405          Blank

 101-130                  Condition Text

            1481          Description of reason for facility stay
            3924          Blank = Source Code equal to 2  or  3  or  D  stay
                                 record or Record Status Code ASF or source
                                 code equal to 1 and record status code not
                                 CRM or only one condition reported

 Tape
 Position   Frequencies   Variable Description and Codes

 (131-164)                Third Reported Condition

 131-132                  Condition Code

             402          01-35 = Condition code (See Appendix B)
            5003          Blank = Source  Code  equal  to  2  or 3 or D stay
                                 record or Record Status Code ASF or source
                                 code equal to 1 and record status code not
                                 CRM or less than three conditions reported

 133-134    5405          Blank

 135-164                  Condition Text

             402          Description of reason for facility stay
            5003          Blank = Source  Code  equal  to 2 or 3 or  D stay
                                 record or Record Status Code ASF or source
                                 code equal to 1 and record status code not
                                 CRM or less than three conditions reported

 Tape
 Position   Frequencies   Variable Description and Codes

 (165-198)                Fourth Reported Condition

 165-166                  Condition Code

             117          01-35 = Condition code (See Appendix B)
            5288          Blank = Source Code equal to 2  or 3  or  D  stay
                                 record or Record Status Code ASF or source
                                 code equal to 1 and record status code not
                                 CRM or less than four conditions reported

 167-168    5405          Blank

 169-198                  Condition Text

             117          Description of reason for facility stay
            5288          Blank = Source  Code equal  to  2  or 3 or D stay
                                 record or Record Status Code ASF or source
                                 code equal to 1 and record status code not
                                 CRM or less than four conditions reported

 Tape
 Position   Frequencies   Variable Description and Codes

 199                      Type of Stay Flag

            83            C = A reported stay with admission date  up to one
                             year prior to the date of last interview (i.e.
                             the NHEFS 1982-84 if interviewed at that  time
                             or  date  of  NHANES  I  Examination  if never
                             interviewed at NHEFS 1982-84).

            20            D = A reported stay with admission date more  than
                             one  year  prior to date of last interview and
                             the facility had not been contacted during the
                             1982-84  NHEFS.    If   there   were  multiple
                             reported stays in the same facility  that were
                             all  type D (more than one year prior to  last
                             interview)  these stays were consolidated into
                             one  entry in  the  tracking  system.   If  an
                             in-scope  abstract was received in response to
                             a  type  D  report,  the  abstract  was  never
                             matched, but  assigned a record status code of
                             ASF (positions  60-62).  The type D report was
                             then removed from  the  file.   The  20 type D
                             reports  remaining  on the final file are  all
                             non-responses from the  facility and thus were
                             not able to be resolved.

            5302     Blank = In-scope stay; a reported  date  of  admission
                             after the last interview date.  This field  is
                             also blank for record status codes of ASF, CRM
                             or CRX (positions 60-62).

                             Note:   This   variable   identifies  reported
                             facility stays as in-scope or out-of-scope for
                             the  NHEFS  1986  interview period.   Reported
                             dates of admission  of  don't know (989898) or
                             not ascertained (999999)  in  positions  47-52
                             were considered in-scope.

 200                      Source  of  Report  of Stay that Initiated Request
                          for Abstract

              36          1 = Information from death certificate
             103          2 = Information from hospital abstract report
              79          3 = Information from other source
            4192          4 = Information from NHEFS 1986 interview
             995          Blank = Not  a requested  stay.   Additional  stay
                            information obtained from facility (record
                            status code ASF positions 60-62).  ASF may
                            also be coded as source code 3.

 201-204    5405          Blank

                          ABSTRACT DATA

                          Note:  The abstract  data  portion  of  the record
                          (positions 205-380) contains information  obtained
                          from  an  abstract  form returned by the facility.
                          This  section  of  the  stay   record   (excluding
                          positions  207-208)  will be blank when a facility
                          did  not  return  an  abstract  form  for  a  stay
                          (n=1496).

 205-206                  Abstract Number

            3909          01-29 = Number of abstract
            1496          Blank = Stay reported, no abstract form received

                          Note: For each subject, a two digit number was
                          assigned consecutively to each abstract form received.

 207-208                  Total Number of Abstracts Received

            5405          00-29 = Total number of abstracts received

                          Note:  This number represents the total  number of
                          abstracts  received  for each subject.  The  total
                          number is repeated on each subject record.

 209                      Facility Record Type

            3496              1 = Hospital
             413              2 = Nursing home
            1496          Blank = Stay reported, no abstract form received

 Tape
 Position   Frequencies   Variable Description and Codes

 (210-215)                Date of Admission

 210-211                  Month of Admission

            3909          01-12 = Month of admission
            1496          Blank = Stay reported, no abstract form received

 212-213                  Day of Admission

            3909          01-31 = Day of admission
            1496          Blank = Stay reported, no abstract form received

 214-215                  Year of Admission

            3909          72-86 = Year of admission (1972-1986)
            1496          Blank = Stay reported, no abstract form received

 Tape
 Position   Frequencies   Variable Description and Codes

 (216-221)                Date of Discharge

                         Note:  When a subject  had  a  brief  break  in  a
                         nursing  home  stay  not due to a hospitalization,
                         the nursing home stays were combined into one long
                         stay with the latest discharge  date  assigned  to
                         the stay.  The information contained in the report
                         and  abstract  sections  of  the  stay is from the
                         earliest abstract.  For example:  subject A was in
                         a  nursing  home  from 10-31-85 to 12-22-85.   The
                         subject was readmitted  to  the  same nursing home
                         1-3-86  and stayed until their death  3-5-86.   No
                         information  is  available for 12-22-85 to 1-3-86.
                         These 2 stays would  appear  on the file as 1 stay
                         from 10-31-85 to 3-5-86.  Length  of stay would be
                         calculated  on  the  entire  stay  (see  positions
                         222-225).   If the break in the nursing  home  was
                         due  to  an  interspersed   hospitalization,   the
                         nursing  homes  stays  were collasped as described
                         above and a code was entered  in  the related stay
                         section (see positions 380-429).

 216-217                  Month of Discharge

            3732          01-12 = Month of discharge
             177             97 = Inapplicable (still at facility on date of
                                  1986 interview)
            1496          Blank = Stay reported, no abstract form received

 218-219                  Day of Discharge

            3732          01-31 = Day of discharge
             177             97 = Inapplicable (still at facility on date of
                                  1986 interview)
            1496          Blank = Stay reported, no abstract form received

 220-221                  Year of Discharge

            3732          72-86 = Year of discharge (1972-1986)
             177             97 = Inapplicable (still at facility on date of
                                  1986 interview)
            1496          Blank =  Stay reported, no abstract form received


 222-225                  Length of Record Stay

              16               0000 = Died on day of admission
            3716          0001-4218 = Total number of days in facility
             177               9997 = Inapplicable (still at facility on
                                      date of 1986 interview)
            1496              Blank = Stay reported, no abstract form received

                         Note:  Length of stay is calculated by subtracting
                         the date of admission  from the date of discharge.
                         For subjects with nursing home stays, brief breaks
                         were collapsed into one  continuous  nursing  home
                         stay   (see positions 216-221).  For subjects with
                         information  coded  in  the  related stays section
                         (see  positions  380-429)  length   of  stay  will
                         include time spent in other facilities.

 226                      Was the Patient in Cardiac Intensive Care Unit?

             379              1 = Yes
            2790              2 = No
             413              7 = Inapplicable (facility is a nursing home)
             327              9 = Not ascertained
            1496          Blank = Stay reported, no abstract form received

 227-229                  Number of Days in Cardiac Intensive Care Unit

             363          000-197 = Number of days
            3530              997 = Inapplicable (position 226 = 2,7,9)
              16              999 = Not ascertained
            1496            Blank = Stay reported, no abstract form received

                         Note:  A length of  stay of 0 days occurred when a
                         subject was admitted  to  the facility and died on
                         the day of admission.

 230                      Was the Patient In Other Intensive Care Unit?

              31              1 = Yes
            2607              2 = No
             413              7 = Inapplicable (facility is a nursing home)
             572              9 = Not ascertained
            1496          Blank = Stay reported, no abstract form received

 231-233                  Number of Days in Other Intensive Care Unit

             310          000-090 = Number of days
            3592              997 = Inapplicable (Position 230 = 2,7,9)
               7              999 = Not ascertained
            1496            Blank = Stay reported, no abstract form received

                         Note:  A length of stay  of 0 days occurred when a
                         subject was admitted to the  facility  and died on
                         the day of admission.

 234                      Patient Admitted to Nursing Home From:

             121              1 = Private residence
             214              2 = Acute care hospital
               6              3 = Chronic disease hospital
              68              4 = Other nursing home
            3496              7 = Inapplicable (facility is a hospital)
               4              9 = Not ascertained
            1496          Blank = Stay reported, no abstract form received

 235                      Disposition of Hospital Patient

            2556              1 = Routine discharge/discharged home
               6              2 = Left against medical advice
             473              3 = Discharged/transferred to another facility
                                  or organization
             135              4 = Discharged/referred to organized home care ser
             268              5 = Died
               7              6 = Not  discharged/still in hospital  on  the
                                  date of 1986 interview
             413              7 = Inapplicable (facility is a nursing home)
              51              9 = Subject discharged, disposition not ascertaine
            1496          Blank = Stay reported, no abstract form received

 236                      Disposition of Nursing Home Patient

             170              1 = Not discharged/still  in a nursing home on
                                  date of 1986 interview
              23              2 = Discharged  to  private residence/referral
                                  to organized home care services
             106              3 = Died
              39              4 = Discharged to private residence/no referral
              75              5 = Transferred to another facility
            3496              7 = Inapplicable (facility is a hospital)
            1496          Blank = Stay reported, no abstract form received

 237                      Transferred to Another Health Care Facility

              37              1 = Acute care hospital
              35              2 = Other nursing home
               0              3 = Chronic disease hospital
               3              4 = Other
            3834              7 = Inapplicable (Position 236 = 1,2,3,4 or 7)
            1496          Blank = Stay reported, no abstract form received

 238-239                  Number of Diagnoses

            3909          01-22 = Number of diagnoses
            1496          Blank = Stay reported, no abstract form received

                         Note:  This variable identifies  the  total number
                         of diagnoses entered on the abstract.   The number
                         of  coded diagnoses may exceed the maximum  number
                         allowed on the data tape (10).

 Tape
 Position   Frequencies   Variable Description and Codes

 240-245                  Principal Diagnosis

            3909          ICD-9-CM Code
            1496          Blank = Stay reported, no abstract form received

                         Note:  See medical coding specifications.

 246-250                  Principal Diagnosis E Code

             299          ICD-9-CM Code
            5106          Blank = Stay  reported,  no abstract form received
                          or principal diagnosis does not require E code

                         Note:  See medical coding specifications.

 251-256                  Second Diagnosis

            3413          ICD-9-CM Code
             496          999997 = Inapplicable (only one diagnosis coded)
            1496           Blank = Stay reported, no abstract form received

                          Note:   See medical coding specifications.

 257-261                  Second Diagnosis E Code

              87          ICD-9-CM Code
             496          99997 = Inapplicable (only one diagnosis coded)
            4822          Blank = Stay reported, no abstract form received
                                  or second diagnosis does not require E code

                          Note:  See mdical coding specifications.

 262-267                  Third Diagnosis

            2794          ICD-9-CM Code
            1115          999997 = Inapplicable (less than three diagnoses
                                   coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 268-272                  Third Diagnosis E Code

              56          ICD-9-CM Code
            1115          99997 = Inapplicable (less   than  three  diagnoses
                                  coded)
            4234          Blank =  Stay reported, no  abstract  form received
                          or third diagnosis does not require E code

                          Note:  See medical coding specifications.

 273-278                  Fourth Diagnosis

            2109          ICD-9-CM Code
            1800          999997 = Inapplicable (less than four diagnoses
                                   coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 279-283                  Fourth Diagnosis E Code

              44          ICD-9-CM Code
            1800          99997 =  Inapplicable  (less  than  four  diagnoses
                          coded)
            3561          Blank = Stay  reported,  no abstract form received
                          or fourth diagnosis does not require E code

                          Note:  See medical coding specifications.

 284-289                  Fifth Diagnosis

            1458          ICD-9-CM Code
            2451          999997 =  Inapplicable (less  than  five  diagnoses
                                    coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 290-294                  Fifth Diagnosis E Code

              24          ICD-9-CM Code
            2451          99997 =  Inapplicable  (less  than  five  diagnoses
                          coded)
            2930          Blank =  Stay  reported,  no abstract form received
                          for fifth diagnosis does not require E code

                          Note:  See medical coding specifications.

 295-300                  Sixth Diagnosis

             946          ICD-9-CM Code
            2963          999997 =Inapplicable  (less  than  six  diagnoses
                          coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 301-305                  Sixth Diagnosis E Code

              25          ICD-9-CM Code
            2963          99997 =  Inapplicable  (less   than  six  diagnoses
                                   coded)
            2417          Blank = Stay reported, no abstract  form  received
                          or sixth diagnosis does not require E code

                          Note:  See medical coding specifications.

 306-311                  Seventh Diagnosis

             602          ICD-9-CM Code
            3307          999997 = Inapplicable  (less  than seven diagnoses
                          coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 312-316                  Seventh Diagnosis E Code

              14          ICD-9-CM Code
            3307          99997 = Inapplicable  (less than  seven  diagnoses
                          coded)
            2084          Blank = Stay reported,  no  abstract form received
                          or seventh diagnosis does not require E code

                          Note:  See medical coding specifications.

 317-322                  Eighth Diagnosis

             418          ICD-9-CM Code
            3491          999997 = Inapplicable (less than  eight  diagnoses
                          coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 323-327                  Eighth Diagnosis E Code

              13          ICD-9-CM Code
            3491          99997 =Inapplicable  (less  than  eight diagnoses
                          coded)
            1901          Blank =  Stay  reported, no abstract form  received
                          or eighth diagnosis does not require E code

                          Note:  See medical coding specifications.

 328-333                  Ninth Diagnosis

             265          ICD-9-CM Code
            3644          999997 =  Inapplicable  (less  than  nine diagnoses
                          coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 334-338                  Ninth Diagnosis E Code

               3          ICD-9-CM Code
            3644          99997 = Inapplicable  (less  than  nine  diagnoses
                          coded)
            1758          Blank = Stay  reported, no abstract form  received
                          or ninth diagnosis does not require E code

                          Note:  See medical coding specifications

 339-344                  Tenth Diagnosis

             160          ICD-9-CM Code
            3749          999997 =  Inapplicable  (less  than  ten  diagnoses
                          coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 345-349                  Tenth Diagnosis E Code

               1          ICD-9-CM Code
            3749          99997 =  Inapplicable   (less  than  ten  diagnoses
                          coded)
            1655          Blank =  Stay reported, no  abstract  form received
                          or tenth diagnosis does not require E code

                          Note:  See medical coding specifications.

 350-351                  Number of Procedures

            3496          00-07 = Number of procedures
             413             97 = Inapplicable (facility is a nursing home)
            1496          Blank = Stay reported, no abstract form received

                         Note:   This variable identifies the total  number
                         of procedures coded on the facility abstract.  The
                         number of  reported procedures from a hospital may
                         exceed the maximum  number  of  five coded on this
                         data tape.

 352-355                  First Procedure

            1192          ICD-9-CM Code
            2717          9997  =  Inapplicable (facility is  a  nursing home
                          or no procedures coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 356-359                  Second Procedure

             471          ICD-9-CM Code
            3438          9997 =Inapplicable  (facility is a nursing  home
                          or only one procedure coded)
            1496          Blank =   Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 360-363                  Third Procedure

             129          ICD-9-CM Code
            3780          9997  = Inapplicable (facility  is  a nursing home
                          or less than three procedures coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 364-367                  Fourth Procedure

              32          ICD-9-CM Code
            3877          9997 = Inapplicable  (facility is a nursing  home
                          or less than four procedures coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 368-371                  Fifth Procedure

              11          ICD-9-CM Code
            3898          9997  =   Inapplicable (facility  is  a nursing home
                               or less than five procedures coded)
            1496          Blank = Stay reported, no abstract form received

                          Note:  See medical coding specifications.

 Tape
 Position   Frequencies   Variable Description and Codes

 (372-373)                Presence of Documents

 372                      Pathology Report

             168          1 = Required and present
              58          2 = Required and not present
            3270          6 = Not required
             413          7 = Inapplicable (facility is a nursing home)
            1496          Blank = Stay reported, no abstract form received

 373                      Third Day EKG Report

             128          1 = Required and present
              50          2 = Required and not present
            3318          6 = Not required
             413          7 = Inapplcable (facility is a nursing home)
            1496          Blank = Stay reported, no abstract form received

 374-379    5405          Blank

 Tape
 Position   Frequencies   Variable Description and Codes

                         RELATED STAY CODES

                         Note:   Residents  in  nursing  homes  are   often
                         admitted  to  hospitals during the course of their
                         stays  in  the nursing  home.   The  related  stay
                         section of the  record  cross-links  nursing  home
                         stays with interspersed hospital stays.

                         In  the  case of nursing home records, this set of
                         variables  identifies hospital stays that occurred
                         during the nursing  home  stay.   Up to 10 related
                         stays can be listed.

                         In  the  case  of  hospital records, this  set  of
                         variables identifies  the nursing home stay within
                         which  the  hospital  stay   occurred.   Only  one
                         related stay is identified for hospital records.

                         The Related Stay is identified  by its Health Care
                         Facility Stay ID Number (positions  29-33)  of the
                         record for that stay.

                         An  example  of  the  usage  of  the  related stay
                         section is found in the introduction to this codebook.

 (380-429)               ID Number(s) of Related Stay(s)

 (380-384)               ID of First Related Stay

 380                     Survey Period Identifier

             283         2 = NHEFS 1986
            5122         Blank = No related stays

 381-382                 Facility Number

             283         01-06 = Hospital/nursing home number
            5122         Blank = No related stays

 383-384                 Stay Number Within Facility

             283         01-21 = Stay number
            5122         Blank = No related stays

 Tape
 Position   Frequencies  Variable Description and Codes

 (385-389)               ID of Second Related Stay

 385                     Survey Period Identifier

              38         2 = NHEFS 1986
            5367         Blank = No second related stay

 386-387                 Facility Number

              38         01-06 = Hospital/nursing home number
            5367         Blank = No second related stay

 388-389                 Stay Number Within Facility

              38         01-09 = Stay number
            5367         Blank = No second related stay

 Tape
 Position   Frequencies   Variable Description and Codes

 (390-394)               ID of Third Related Stay

 390                     Survey Period Identifier

              13         2 = NHEFS 1986
            5392         Blank = No third related stay

 391-392                 Facility Number

              13         01-05 = Hospital/nursing home number
            5392         Blank = No third related stay

 393-394                 Stay Number Within Facility

              13         01-08 = Stay number
            5392         Blank = No third related stay

 Tape
 Position   Frequencies   Variable Description and Codes

 (395-399)                ID of Fourth Related Stay

 395                      Survey Period Identifier

               6          2 = NHEFS 1986
            5399          Blank = No fourth related stay

 396-397                  Facility Number

               6          01-03 = Hospital/nursing home number
            5399          Blank = No fourth related stay

 398-399                  Stay Number Within Facility

               6          02-06 = Stay number
            5399          Blank = No fourth related stay


 Tape
 Position   Frequencies   Variable Description and Codes

 (400-404)                ID of Fifth Related Stay

 400                      Survey Period Identifier

               2          2 = NHEFS 1986
            5403          Blank = No fifth related stay

 401-402                  Facility Number

               2          03 = Hospital/nursing home number
            5403          Blank = No fifth related stay

 403-404                  Stay Number Within Facility

               2          04-08 = Stay number
            5403          Blank = No fifth related stay

 Tape
 Position   Frequencies   Variable Description and Codes

 (405-409)                ID of Sixth Related Stay

 405                      Survey Period Identifier

               2          2 = NHEFS 1986
            5403          Blank = No sixth related stay

 406-407                  Facility Number

               2          03 = Hospital/nursing home number
            5403          Blank = No sixth related stay

 408-409                  Stay Number Within Facility

               2          01-10 = Stay number
            5403          Blank = No sixth related stay

 Tape
 Position   Frequencies   Variable Description and Codes

 (410-414)                ID of Seventh Related Stay

 410                      Survey Period Identifier

               1          2 = NHEFS 1986
            5404          Blank = No seventh related stay

 411-412                  Facility Number

               1          03 = Hospital/nursing home number
            5404          Blank = No seventh related stay

 413-414                  Stay Number Within Facility

               1          11 = Stay number
            5404          Blank = No seventh related stay

 Tape
 Position   Frequencies   Variable Description and Codes

 (415-419)                ID of Eighth Related Stay

 415                      Survey Period Identifier

               1          2 = NHEFS 1986
            5404          Blank = No eighth related stay

 416-417                  Facility Number

               1          03 = Hospital/nursing home number
            5404          Blank = No eighth related stay

 418-419                  Stay Number Within Facility

               1          12 = Stay number
            5404          Blank = No eighth related stay

 Tape
 Position   Frequencies   Variable Description and Codes

 (420-424)                ID of Ninth Related Stay

 420                      Survey Period Identifier

               1          2 = NHEFS 1986
            5404          Blank = No ninth related stay

 421-422                  Facility Number

               1          03 = Hospital/nursing home number
            5404          Blank = No ninth related stay

 423-424                  Stay Number Within Facility

               1          13 = Stay number
            5404          Blank = No ninth related stay

 Tape
 Position   Frequencies   Variable Description and Codes

 (425-429)                ID of Tenth Related Stay

 425                      Survey Period Identifier

               1          2 = NHEFS 1986
            5404          Blank = No tenth related stay

 426-427                  Facility Number

               1          03 = Hospital/nursing home number
            5404          Blank = No tenth related stay

 428-429                  Stay Number Within Facility

               1          01 = Stay number
            5404          Blank = No tenth related stay



Figure 1: Health Care Facility Record Layout
 _____________________________________________________________________________
   Facility identifiers!               ! Actual dates      !Codes assigned by
   Reported date of    !    Match      ! admission and     !NCHS to identify
   admission           !      or       ! discharge         !stays contained
   Reported cause o    !  reason for   ! ICD-9-CM diagnoses!within other stays
   admission           !  non-match    ! Discharge status  !
   Source  of  report  !               ! from hospitals and!
                       !               ! nursing homes     !
 ______________________________________________________________________________
                        Record                                   Related
   Report Section       Status Section   Abstract Section        Stay section


Figure 2: Example of Matching Process and Record Status Codes

        Record status code

                Match                  Report Section! Mat !Abstract Section
                                       ______________!_____!__________________

                                                         non-
               Non-match               Report Section!  match !No Abstract
                                                         code    received
                                       ______________!________!______________

             Additional
             abstract          No report section  ! ASF  ! Abstract Section
              found
                               ___________________!______!____________________



APPENDIX A 1986

 Appendix A: Record Status Codes

 Code   Frequency  Description

 ANO -   28  "Authorization  Not  Obtained."  This code indicates that that
             subject or proxy refused to sign the Medical Authorization  For
             (MAF). These  stays  are  not requested from the  reported
             facilities.

 ASF - 1063  "Additional Stay Found." This code was assigned when a received
             stay could not be matched to a reported stay and the received stay
             is in-scope.  This code was also assigned to  in-scope  stays that
             were  received  as  a  result of an inquiry generated by a type
             report (Position 199).   The  type  D  report was deleted from the
             final file.

 CRM -  124  "Cross-Referenced Match."  This code indicates a stay that was
             begun prior to the NHEFS 1986 survey period and continues into the
             1986  survey  period.   For  this  type  of  stay, the abstract is
             brought  forward from the previous wave. The discharge date  and
             discharge  status  information  are the only positions that are
             updated. The admission date is prior to the 1982-84  interviev
             because this is a continuing  stay. Thus,  it appears but is no
             out-of-scope for 1986.

 CRX -    8  "Cross-Referenced Non-Match."  A code assigned by NCHS staff to
             close out a stay that was begun in a previous wave and was
             reported  to have continued into the 1986 Survey  period, yet no
             in-scope stay was received for the 1986 survey period.

 FNC -   90  "Facility Never  Contacted." This  code  was  assigned when the
             facility  was  not  contacted  for  the  following  reasons: the
             respondent could not recall the name of the facility; the facility
             was  closed;  the  facility  could  not  be  located; and facility
             located outside the United States.

 MAT -  2722 "Record  Match."  This code was assigned when a received  stay
             matches a reported stay. This code was assigned to in-scope and
             type  C  (position  199)  reports, but never to  type  D reports.
             In-scope stays that were received as the result of a type D report
             were assigned an ASF code.  See ASF.
 ONR -  276  "Other Non-Response."This code is assigned  to a stay when no
             response for the stay request has been received from the facility
             by the end of the study period.

 REF -  189  "Refused."  This code is assigned after a facility refuses to send
             back  the  stay  record  requested.   It  is  record, not subject
             specific.   For  example, a facility may send some records  for
             subject but refused to send others.

 XNH -  212  "Subject Never at  Facility." This code is used when the facility
             indicates that the patient was never admitted to that facility.

 XNS -  686  "Other - No Stay Found." This  code  is assigned when a facility
             responds it is unable to send records because an in-scope stay was
             not  found  at  this facility, or when the  facility  returns  the
             request form without  records  and provides no explanation for the
             failure to provide records.

 XRD -    7  "Record Destroyed or No Longer Available." This code is assigned
             if the facility attempts to locate the record  and  states  it no
             longer exists, i.e., destroyed, lost.

 NOTE:   Additional  information  concerning  the  assignment of the record
 status codes is found in the introduction to this codebook.


APPENDIX B 1986
Numeric Codes for Reported Conditions

 Code for            Condition
 Reported Condition  Description

      01             Arthritis
      02             Gout
      03             Heart attack
      04             Another heart condition besides heart attack
      05             Coronary bypass surgery
      06             Pacemaker repair, insertion and/or replacement
      07             T.I.A., small stroke
      08             Stroke or CVA (cerebrovascular accident)
      09             Diabetes
      10             High Blood Pressure
      11             Cancer and/or cancer treatment
      12             Fractured hip
      13             Another type of bone fracture besides a hip fracture
      14             Pneumonia or flu
      15             Surgery
      16             Don't know
      18             Tests/observation/x-rays/physical exam
      19             Digestive/endocrine condition
      20             Respiratory condition (other than influenza and pneumonia)
      21             Infection
      22             Kidney/bladder/urinary condition
      23             Debility/pain
      24             Male reproductive condition
      25             Musculoskeletal problem or injury other than a fracture
      26             Circulatory condition
      27             Female reproductive condition
      28             Mental illness
      29             Neurologic condition
      30             Nutritional condition or dehydration
      31             Bleeding or blood disorder
      32             Skin condition
      33             Condition not elsewhere coded
      34             Admission to a facility other than an acute care hospital
      35             In a facility at time of death
      36             Cataracts
      37             A fall

 During the process of completing the Hospital and Health Care Facility (HHCF)
 chart  respondents were asked to describe the conditions that  led  to  their
 facility  stays  and this information is included as a text field on the stay
 record.  The text portion of the reported condition contains the respondent's
 own words if possible  or a summary of the respondent's description which was
 edited to fit into the 30  positions.   A  numeric  code was also assigned to
 each description.  This was done so that users would  not  have  to deal with
 alphabetic description fields when investigating reasons for facility  stays.
 Space  is  allotted  on  the  report  section of the facility stay record for
 recording of up to four reasons for the  hospitalization or nursing home stay
 (positions 63-198 of the HCFS record).

 Note that code "17" is not included in the  coding  structure  for  the  1986
 file.   This  code was designated for use when the reported condition is "not
 ascertained", a  situation  which  never arose during the construction of the
 1986 HCFS file.

 Reported conditions and their associated  codes can be divided into six types
 depending on where in the interview the stay  was  reported and the amount of
 information obtained:  specific conditions included  in Section B or F of the
 interview  (Type  A);  conditions which are well-defined  but  for  which  no
 question exists in Section  B  of  the interview (Type B); unknown conditions
 (Type C); conditions about which there  is  no specific question in Section B
 but  for  which  sufficient information is available  to  attribute  them  to
 disorders of a major  body  system  (Type  D);  conditions  that  are broadly
 defined  and/or cannot be attributed to a single major body system (Type  E);
 and conditions  that  cannot  be  classified into any of the above categories
 (Type  F).  Each condition type, the  associated  codes  and  the  rules  for
 assigning  the  reported conditions to the categories of the coding structure
 are described in detail below.

Type A

 Type A - Conditions about which the respondent was asked in section B or F of
 the interview.  For example, if a respondent answered "yes" to question B-13a
 ("Were you hospitalized  for your arthritis?"), then a condition code of "01"
 and a text field containing  "arthritis"  would  be  included on the facility
 stay record.  Type A conditions are:

           01   Arthritis (B-13a)
           02   Gout (B-13a)
           03   Heart attack (B-19a)
           04   Other heart conditions (B-19b)
           05   Coronary bypass surgery (B-20b)
           06   Procedures for pacemakers (B-20d)
           07   T.I.A., small stroke (B-26)
           08   Stroke (B-32)
           09   Diabetes (B-39)
           10   High blood pressure (B-45)
           11   Cancer (B-48 or B-51)
           12   Fractured hip (B-57)
           13   Bone fracture other than hip (B-61)
           14   Pneumonia or influenza (B-62)
           15   Surgery (B-63)
           34   Care in non-acute care facility (B-69)
           35   In a facility at death (B-80 proxy questionnaire)
           36   Cataracts   (F-5)   Note:   This  question  was   located   in
                Section F.

 Complete agreement between responses to the  questions in section B and F and
 Type  A condition codes on the facility stay file  should  not  be  expected.
 There are  several  reasons  for  a  lack of agreement between these two data
 sources.

 First, the respondent may report a facility stay for a given condition in the
 interview and yet no facility stay record containing the condition may appear
 on the HCFS file.  This would result if:  (1)  it  was  determined  that  the
 hospitalization  did  not  last overnight causing the stay to be deleted from
 the HCFS file; or (2) the reported  stay  was  found  to  be "out-of- scope".
 (See  the  introduction  to  this  codebook  and  the Plan and Operation  for
 definitions of out-of-scope stays.)

 Second, data may be inconsistent between the interview  and  the HCFS file if
 the  respondent remembered and reported a condition after responding  to  the
 corresponding  question  in  Section B or F of the interview.  This tended to
 occur at the time the interviewer  was  recording  information  on  the  HHCF
 chart.   For  example,  while  recording information on a stay for high blood
 pressure, the respondent may add  that  he/she  was also hospitalized at that
 time  for  a  heart  condition.   The respondent may not  have  reported  the
 hospitalization when asked about heart  conditions  in question B-19a and the
 Section  B information may not have been updated to reflect  this  additional
 condition.  However, heart condition would appear on the HCFS file.

Type B

 Type B - Conditions  which  do not have a corresponding question in Section B
 of  the  interview  but  for  which  sufficient  descriptive  information  is
 available to allow them to be easily coded:

           18   Tests and observation
           37   A fall

Type C

 Type C - Unknown conditions:

           16 Don't know

Type D

 Type D - Conditions for which there is not a specific question in Section B
 of the interview but which can be attributed to disorders of a major body
 system:

           19   The digestive/endocrine system
           20   The respiratory system (excluding flu or pneumonia)
           22   Kidney, bladder or urinary problem
           24   The male reproductive system
           25   The musculoskeletal system
           26   The circulatory system (except strokes)
           27   The female reproductive system
           29   Neurologic disorders
           31   Blood disorder/bleeding
           32   Skin problem

Type E

 Type E - Conditions which are broadly defined or are attributed to  problems
 of more than one major body system:

           21   Infections
           23   Debility and pain
           28   Mental illness
           30   Nutrition and dehydration

Type F

 Type F - All conditions that cannot be assigned to one of the above codes:

           33   Other conditions

Additional Information

 Additional  information  on  reasons  for a facility stay is available in the
 abstract  section  of  the record (positions  205-379)  if  an  abstract  was
 received from the facility.   In  general  information  from  the abstract is
 considered  a  more accurate determination of the conditions associated  with
 the stay than are the reported conditions.  The condition codes in the report
 section of stay  records  do  provide  useful information in the absence of a
 medical abstract.  Both flexibility and  caution  should  be  exercised  when
 selecting stays based on these codes.  In order to help the analyst use these
 condition  codes  effectively, a description of the code assignment procedure
 along with an example is provided.


Rules for Assignment

 The  numeric  codes  were   assigned   to   the   respondent's  non-technical
 descriptions by trained medical coders.  In order to minimize variation among
 the coders assigning these codes, precedence rules  were defined.  Generally,
 a  condition was coded to the most specific category in  which  it  could  be
 placed.   The  assignment  rules  are described below in priority order, e.g.
 Rule 2 was used only if Rule 1 did not apply and so forth.

 Rule 1:   If a condition was one about which there was a specific question in
           Section B or F of the interview,  the  code  appropriate  for  that
           question was assigned.  (Type A conditions)

 Rule 2:   If  the  textual  description  could be coded to a narrowly defined
           condition not referenced in Section  B  or to the unknown category,
           the appropriate Type B or Type C code was assigned.

 Rule 3:   Conditions that could not be coded to a specific question but could
           be coded to a major body system were assigned  the appropriate Type
           D code.

 Rule 4:   General descriptions, symptoms and conditions not  coded by rules 1
           through 3 were coded at the discretion of the medical  coder, again
           with  emphasis  on  as  much specificity as possible.  For example,
           "HEADACHES, BRAIN TUMOR"   would  be  coded  to  "29  -  Neurologic
           disorders",  not  to  "23 - Debility and pain".  (Type D or Type  E
           conditions).

 Rule 5:   Everything that could not  be  assigned  a  code after applying the
           above  rules  was  coded  to  "33  -  Other conditions".   (Type  F
           conditions).

Considerations for the Data User

 These precedence rules were used for all three followups.  However, since the
 questionnaires  used in each followup differed slightly,  the  assignment  of
 codes also differed.   Questions  about  specific  conditions were not always
 included in all three questionnaires.  For example, Question B-63 in the 1986
 interview asked about overnight stays for surgery making  condition  code "15
 -Surgery"  a  Type  A  condition  in  the 1986 followup.  There is no similar
 question in the 1982-84 or 1987 interview,  therefore,  surgery  is  a Type E
 condition  in  the  1982-84  and  1987  files.   In  other  cases,  groups of
 conditions  are  combined  into  one  question on one questionnaire but asked
 separately on another.  For example, T.I.A.'s  and other strokes are combined
 in one question in 1987.  Since it was not possible  to  separate  reports of
 T.I.A.'s  from  other  strokes  in  the  1987  file,  there are no conditions
 assigned to codes "07" in this file.  There are reports  assigned  to "07" in
 the  1982-84  and 1986 files since separate T.I.A. and stroke questions  were
 asked.  An attempt  was  made  to  include  as  much  detail  in  the code as
 possible.   The questionnaire in the 1982-84 followup included enough  detail
 to separate specific  digestive  conditions,  such as colitis and gallbladder
 problems, from the general category of digestive  disorders.   Therefore, the
 1982-84  HCFS  data  file, includes sub-codes under "19 - Digestive/endocrine
 system".  Thus, analysts  interested  in  colitis can identify cases from the
 reported condition section of the 1982-84 file  but not from the 1986 or 1987
 files.   However,  all  files  can  be  used  to  identify   cases   of   the
 digestive/endocrine  system  in  general.   The  analyst  should refer to the
 questionnaire  and  the  condition  coding  structure in the HCFS  data  tape
 codebook for the period of interest in order  to obtain the maximal amount of
 information available.

 In   using  the  condition  codes  to  select  records   of   interest,   two
 characteristics  of  the  coding  structure  should  be  considered:  (1) the
 condition of interest may be found under more than one numeric  code  and (2)
 each numeric code covers more than one condition.

 To  illustrate  the first situation, consider a search for all reported stays
 with breast biopsies.   A respondent might report a breast biopsy in response
 to the question relating  to  cancer  and cancer treatment.  In this case the
 textual field would contain a description  such  as  "BIOPSY OF RIGHT BREAST"
 and  the  numeric code assigned would be 11 (indicating  a  response  to  the
 cancer stay question).  Breast biopsies could also be reported in response to
 the surgery question in the 1986 followup and be assigned the code of 15.  If
 the  biopsy   was   reported  in  response  to  question  B-83  on  the  1987
 questionnaire, "Have  you  stayed in a hospital for any other reason...?", it
 would be assigned to code 18  -  Tests  and observation".  To identify breast
 biopsy cases it would be necessary to search  the alphabetic fields for codes
 11, 15 and 18.  In addition, the reports of breast  biopsies  include several
 wording  variations,  for example, "BREAST BIOPSY", "BIOPSY OF BREAST".   The
 analyst needs to investigate all possible wordings.

 To  illustrate  the  second   situation,   consider  code  18  -  "Tests  and
 observation".   Over 250 different verbal descriptions  have  been  coded  to
 this  category  including a variety of radiological procedures, surgeries and
 physical examinations.   Selecting  just  on  code  18  will result in a wide
 variety of procedures.  Those of a specific interest need to be identified by
 the textual description.

 Analysts  who  wish  to use these reports, should print and  review  all  the
 reported condition codes  and  alphabetic  descriptions  from the Health Care
 Facility  Stay  data  files.  Such a review will aid in (1) finding  all  the
 numeric condition codes  under  which the condition of interest will be found
 and (2) insuring that, within any numeric condition code, only the reports of
 interest will be selected.

 Finally,  the  condition  codes in the  report  section  should  be  used  in
 conjunction with the information  in the abstract section if it is available.
 Returned abstracts were matched to  reports if one of the reported conditions
 matched one of the discharge diagnoses on the abstract.   Other conditions
 reported for the same stay may or may not be confirmed in the matched medical
 abstract.   If  the  condition  of  interest is not indicated as a  discharge
 diagnosis on the medical record, the  analyst  may  not  want  to  accept the
 reported  condition as a reason for the stay.  Similarly, conditions  may  be
 listed as discharge  diagnoses that do not appear on the report section.  See
 the introduction to this codebook for a description of the matching rules.




This page last reviewed: Thursday, January 28, 2016
This information is provided as technical reference material. Please contact us at cwus@cdc.gov to request a simple text version of this document.
TOP